Structural Barriers Research Articles

TB treatment delays and associated risk factors in Dushanbe, Tajikistan, 2019–2021

BackgroundIn Tajikistan, where there are about 8,000 cases annually, many new cases are being diagnosed with severe disease, indicating a delay in receiving care. We aimed to estimate the proportion with delayed care and the main factors contributing to delayed care.MethodsUsing a retrospective cohort design, we conducted a study that included all people aged over 15 years who were newly diagnosed with pulmonary TB in Dushanbe from 2019 to 2021. We defined ‘patient delay’ as > 14 days from TB symptom onset to the first provider visit and ‘provider delay’ as > 3 days from the first visit to treatment initiation. Data was abstracted from medical records and participants were interviewed in-person. Multivariable negative binomial regression was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI).ResultsOf 472 participants, 49% were male, 65% had lung tissue cavitation, 33% had drug resistant TB, 11% had diabetes, 4% had HIV, and. Reported cases dropped from 196 in 2019 to 109 in 2020 and increased to 167 in 2021. The proportion of people experiencing patient delays was 82%, 72%, and 90% per year, respectively. The proportion of provider delays was 44%, 41% and 29% per year. Patient delay was associated with year (aRR: 1.09 [CI:1.02–1.18] in 2021 vs. 2019), age (aRR:0.91 [0.82–0.99] for 40–59-year-olds vs. 15–39-year-olds), having HIV (aRR:1.22 [1.08–1.38]), having blood in sputum (aRR:1.19 [1.10–1.28]), chest pain (aRR:1.32 [1.14–1.54]), having at least two structural barriers vs. none (aRR:1.52 [1.28–1.80]), having one of the following barriers: long wait lines (aRR:1.36 [1.03–1.80]), feeling that healthcare services were expensive (aRR:1.54 [1.28–1.85]), or having no time or too much work (aRR:1.54 [1.29–1.84]). Provider delay was associated with year (aRR: 0.67 [0.51–0.89] in 2021 vs. 2019), patients having to pay for X-ray services (aRR: 1.59 [1.22–2.07]) and lacking direct-observed-therapy (DOTS) in facility (aRR: 1.61 [1.03–2.52]).ConclusionsPatient delay was high before the COVID-19 pandemic and increased in 2021, while provider delay decreased during this time. Addressing structural barriers to healthcare services, such as increased DOTS facilities, expanded hours, and zero fees, may decrease delays.

Medications for opioid use disorders among incarcerated persons and those in the community supervision setting: exploration of implementation issues with key stakeholders

IntroductionReceipt of medications for opioid use disorder (MOUD) critically reduces opioid-related mortality during the post-incarceration period. Optimal provision of this care to individuals on community supervision (i.e., probation) requires an understanding of this unique and complex system at the local level.MethodsWe conducted in-depth individual interviews with key treatment providers and probation staff (n = 10) involved with the provision of MOUD to individuals on community supervision in the Northeast. Interviews explored perspectives on the provision of MOUD and support services during the community supervision period. Thematic analysis was conducted to describe inductive and deductive codes, subcodes, and themes.ResultsStakeholders shared diverse attitudes about the benefits and drawbacks of MOUD utilization. The provision of MOUD during the community supervision period was perceived to be influenced by both treatment and probation organizational characteristics, including the structures and values of the agencies. As such, the specific context of the community supervision setting facilitated and impeded MOUD delivery. Persistent challenges to enhancing MOUD delivery to this population remain including widespread MOUD stigma, inter-agency communication issues, and structural barriers to healthcare (i.e., transportation, finances).ConclusionsThere are opportunities to enhance access to evidence-based OUD treatment for persons on community supervision by engaging probation agencies and community treatment staff in systems change.

Stigmas experienced by sexual and gender minority people with HIV in the Dominican Republic: a qualitative study.

As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings. We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics. Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software. On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide. Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.

Roma in the COVID-19 Crisis: Transformative Elements That Emerge from the Research

Research on the impact of the COVID-19 pandemic on the Roma community consistently demonstrates that it has exacerbated pre-existing social exclusion and marginalization. However, few studies have specifically addressed the transformative actions or strategies that helped to mitigate these adverse effects. This study aimed to identify and analyze transformative elements through a systematic review, following PRISMA guidelines. The search was conducted across Web of Science, SCOPUS, and Google Scholar, yielding 995 records, of which 46 were included in the final phase and 25 in our synthesis. Our analysis focused on community-led initiatives that addressed inequalities, particularly when Roma community members were involved in the design of solutions or took on mediation roles. The results underscore the critical importance of inclusive, community-driven actions in overcoming structural barriers and promoting long-term resilience within Roma communities during the pandemic.

Factors Associated With First-Trimester Prenatal Care Initiation In The United States: A Scoping Review.

First-trimester prenatal care is an important component of quality care during pregnancy and is associated with improved perinatal outcomes. Despite its importance, many pregnant people delay prenatal care initiation or receive no prenatal care. This scoping review assessed multilevel factors associated with first-trimester prenatal care initiation in the United States among studies that included a measure of prenatal care timing, using the socioecological model as an organizing framework. A scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines for reporting. PubMed, Cochrane, Embase, CINAHL, and Social Sciences Abstracts were searched for peer-reviewed papers that focused on facilitators and barriers associated with first-trimester prenatal care initiation, were written in English, included a measure of prenatal care timing, and used data gathered after 2014. Of the 1469 articles identified in the search, 19 met inclusion criteria and were included in the final review. Articles described intrapersonal, interpersonal, and environmental-level barriers and facilitators of first-trimester prenatal care initiation including Medicaid expansion, immigration status, and the COVID-19 pandemic. Significant heterogeneity in the measurement of prenatal care timing existed across studies. Our findings suggest that, although environmental domain factors have been impactful toward increasing population-level rates of first-trimester prenatal care initiation, benefits have not been equitable across sociodemographic factors. Increasing the proportion of pregnant people who initiate first-trimester prenatal care will require comprehensive efforts that address sociodemographic and contextual factors, including persistent structural and systemic barriers that cause and widen health disparities.

Novel metamaterial wave barrier structure with multiple frequency wide band gaps for rail transit vibration isolation

As a new kind of artificial composite material, locally resonant phononic crystal (LRPC) can attenuate and suppress the propagation of elastic waves in certain frequency range, which has a broad application prospect and value in the field of vibration and noise control. The traditional LRPC can only open one band gap (BG), but the vibration and noise in practical engineering are often multi-band, so the traditional LRPC cannot effectively cover the target frequency range, and the efficiency of vibration and noise reduction is greatly limited. In response to the shortcomings of traditional LRPC, this paper designs a novel locally resonant phononic crystal with multiple primitive cell combination structure (LRPCWMPCCS), which is a locally resonant supercell structure composed of five types of locally resonant single primitive cells. Firstly, the band structure of the LRPCWMPCCS is calculated using the finite element method, and compared with the band structure of traditional LRPC. Secondly, the frequency response function of the LRPCWMPCCS is calculated to evaluate its attenuation effect on elastic waves in the BG frequency range, and the generation mechanism of its locally resonant BG is explored by analyzing the displacement field and energy distribution characteristics at the BG edge. Then, the equivalent model of the LRPCWMPCCS is established for theoretical calculation of the BG range. Finally, the vibration isolation performance of LRPCWMPCCS wave barrier in practical engineering is analyzed, and the application prospects of the LRPCWMPCCS are discussed. The results show that the LRPCWMPCCS designed in this paper can open the multifrequency BGs, and the BGs width is wider. The number of BGs opened is positively correlated with the type of primitive cells inside the LRPCWMPCCS. Within the BG frequency range, the LRPCWMPCCS has a good attenuation effect on vibration waves, with attenuation values exceeding 20 dB. The spring-mass system equivalent model of the LRPCWMPCCS can accurately calculate its BG range and has good accuracy. The LRPCWMPCCS wave barrier has remarkable control and attenuation effect on vibration. Among them, the maximum vibration acceleration of traditional LRPC wave barrier and LRPCWMPCCS wave barrier is reduced by 18.51% and 39.50%, respectively. The relevant research results of this paper have great value and prospects in the design of LRPC with multifrequency and wide BGs, which can also provide a new method and idea for solving vibration and noise problems.

"Our Voices Will Get Louder": A Qualitative Exploration of Factors Influencing Arab/Middle Eastern North African (MENA) American Patient Participation in US-Based Health Care and Health Research.

Heightened anti-Arab/Middle Eastern and North African (MENA) xenophobia in the United States (US) coupled with the addition of a MENA category on the next US Census call into attention the health needs of this minoritized population. Targeted research is needed to better understand the factors that influence Arab/MENA American participation in US-based health research and health care. A novel qualitative interview guide was constructed to better understand the health research experiences, health care experiences and needs of Arab/MENA patients nationally. Patients were recruited through the Arab American Health Network Alliance (AAHNA) community connections. Semi-structured interviews were conducted virtually in English and Arabic, and qualitative data was interpreted through iterative thematic analysis using inductive reasoning. A total of seventeen interviews (n = 17) were completed (14 in English, 3 in Arabic). Notably, the majority identified as female (82%) and have resided in the US for 18years or longer (53%). Three main themes were identified (1) Individual-level Comfortability and Access to Research Participation, (2) Advancing Community Health Outcomes and Participation, and (3) Structural Barriers as Drivers of Health Disparities. The health research and health care experiences explored in this project have the potential of informing future inquiries on Arab/MENA American health. For instance, we suggest building community trust, providing equitable compensation and support, increasing health workforce diversity, and advocating for affordable health care, all to improve Arab/MENA patient participation in health research.

Measuring the One Health impacts associated with creating access to veterinary care before and during the COVID-19 pandemic

Integrating community perceptions into One Health assessments is critical to understanding the structural barriers that create disproportionate health outcomes for community members, their pets, and the ecosystems that encompass them, particularly in historically marginalized and under-resourced communities. The validated One Health Community Assessment (OHCA) survey instrument was used to evaluate the associated impacts of The Humane Society of the United States’ Pets for Life (PFL) programming on communities’ perceptions of One Health. This evaluation took place across two phases, totaling four years. In phase one (May 2018 – December 2019), the PFL intervention was administered to one urban and one rural under-resourced community, while two demographically-paired communities served as comparison sites. Five OHCA subscales (human health, pet health, environmental health, community health, perceived links) were employed to measure changes in perceptions of One Health and fourteen OHCA items were used to measure perceptions of access to human healthcare, pet care, and the environment. Initiation of the confirmatory second phase of the study (May 2020–October 2021), in which all four communities received the intervention, coincided with the onset of the COVID-19 pandemic. The pandemic and its resulting public health mandates hindered both PFL programming and data collection. Generalized Estimating Equations were employed in both the first and second phase analyses to model changes in perceptions of One Health associated with the PFL intervention. In the study’s first phase, PFL in the urban community was associated with significant increases in perceptions of community health and environmental health, and perceived access to human health care, pet care, and the environment. The presence of PFL during the study’s second phase was associated with increased perceptions of environmental health. The variables of PFL and the pandemic were not able to be isolated within the analyses. However, due to the severe, negative One Health implications associated with the COVID-19 pandemic, the phase two results were interpreted from the perspective of the pandemic being the largest driver of the results. The results are consistent with previous research on the effects of the pandemic on community perceptions of health. These findings offer initial support for the hypothesis that deployment of resources focused on companion animals may affect perceptions across the One Health triad and confirms previous research on effects of the COVID-19 pandemic.

PREVENÇÃO E MANEJO DO DECLÍNIO COGNITIVO NA POPULAÇÃO IDOSA – UMA REVISÃO DE LITERATURA

Population aging has intensified challenges related to elderly health, with cognitive decline being one of the most prevalent and impactful conditions. This review addresses the main strategies for preventing and managing cognitive decline in the elderly, emphasizing evidence-based interventions. Studies show that regular physical activities, such as aerobic exercises and dancing, promote neuroplasticity and preserve cognitive functions. Additionally, balanced diets, notably the Mediterranean diet, exhibit neuroprotective effects. Psychological support, through techniques like mindfulness and cognitive-behavioral therapy, and cognitive stimulation using tools like memory games, complement preventive and therapeutic approaches. However, socioeconomic, cultural, and healthcare access barriers still hinder the widespread implementation of these strategies. Integrated public policies and interdisciplinary programs, aligned with the social determinants of health, are crucial to mitigating the impacts of this condition. This study emphasizes the importance of personalized, accessible, and culturally adapted interventions, highlighting the need for joint efforts among healthcare professionals, policymakers, and society to promote healthy aging and improve quality of life. Overcoming structural barriers and expanding preventive programs are identified as essential pillars to enhance elderly care and reduce the burden of cognitive decline on healthcare systems.

Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications

ABSTRACT HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV.

Uncovering structural barriers to youth engagement in professional sports in Belgrade: A qualitative study.

Abstract The structural barriers faced by young athletes in Belgrade during their transition to professional sports are analyzed in the context of socio-economic changes, with particular focus on the impact of transitioning to adulthood in post-socialist societies like Serbia. Utilizing the theoretical approach of social biography, the study examines how social structures and individual actions shape the life trajectories of these young athletes. The qualitative research includes semi-structured interviews with athletes from professional clubs in Belgrade, the epicenter of sports activities in the country. The aim is to identify the key structural barriers that hinder the professional development of athletes and to analyze the strategies they use to overcome these obstacles. The findings show that these challenges result from the complex interaction of socio-structural constraints and reliance on family resources, significantly shaping their social biographies and careers in sports.

Mitigation of hydroelastic responses of a very large floating structure by flexible porous barriers

The role of a vertical flexible porous barrier of two different configurations, namely (i) surface-piercing barrier (SPB) and (ii) bottom-standing barrier (BSB) in the mitigation of hyroelastic responses of a very large floating structure (VLFS) is analysed. Both the flexible barrier and the floating plate are modelled using Euler-Bernoulli beam equation under the assumption of small amplitude structural response. The solution of the associated mathematical problem is obtained using the eigenfunction expansion method. Various results illustrating the effect of the barrier length, porous-effect parameter, and the barrier-VLFS spacing on various hydroelastic responses of the VLFS are presented. Moreover, results on barrier deflection and overturning moments of the flexible porous barrier for various structural parameters are presented. Energy identity is derived using Green’s identity and used to check the accuracy of the computational results. The study reveals that for suitable values of the structural flexibility, porosity and barrier configurations, wave-induced structural responses on the VLFS and barriers can be reduced significantly. Moreover, the study depicts that the presence of flexible porous barriers can significantly reduce the wave reflection and wave forces exerted on the floating elastic plate.

Predictors of frequency of CF care in the US Cystic Fibrosis Foundation Patient Registry.

Prolonged gaps in care of >12-months are frequent among people with cystic fibrosis (pwCF) and are associated with reduced lung function. Comprehensive analysis of patient-level predictors of visit frequency is needed to optimize protocols for stable pwCF and identify subgroups at high risk of gaps and poor outcomes, promoting equitable treatment for all pwCF. To determine sociodemographic and disease-related factors predictive of visit frequency in pwCF and to assess how these effects vary across the lifespan. We conducted an observational cohort study using data from 2004-2016 for pwCF aged 6-60 years in the US Cystic Fibrosis Foundation Patient Registry. We modeled the relationship between patient-level characteristics and between-visit interval (BVI) using multivariable longitudinal semiparametric regression. BVI was defined as the number of days from the index encounter to the previously recorded visit. The study included 28,588 pwCF with 859,568 encounters. Overall, 55% of visits occurred within 90 days of the prior visit, adhering to national guidelines. On average, adults without common CF-complications attended clinic approximately every 4 months, with a BVI ≥ 110 days from age 23-56. Males attended clinic less frequently than females (9.8% longer BVI; 95% CI 9.1%, 10.5%; p<0.001), as did non-white individuals (3.6% longer BVI than whites; 95% CI 2.2%, 5.0%; p<0.001), with the greatest differences seen in young adults. Those with public and private insurance largely adhered to current guidelines (maximum average BVI of 90 and 95 days, respectively). In contrast, uninsured individuals over age 25 had a mean BVI ≥ 30 days longer than the insured. Frequent visits in those with CF-complications likely reflects higher need, while less frequent visits in male, non-white, and uninsured individuals may reflect patient-preference or structural barriers to care. Risk factors for gaps in care should inform changes to CF care recommendations going forward.

Shear Wave Optical Coherence Elastography and Structural Analysis of the Postnatal Mouse Cornea Through Development

ABSTRACTThe cornea is a transparent lens at the forefront of the eye, serving as a structural barrier that protects the eye and provides the majority of the eye's refractive power. In this study, we utilized the postnatal mouse eye to characterize corneal structure and biomechanics. Between postnatal day (PN) 6 and PN24, we observed that elastic wave speeds are highest at PN6, gradually decrease through PN24, and then start to rise in adulthood (6 months). We found that corneal thickness is uncoupled from elastic wave speed and that the content and organization of the cornea primarily influence its mechanical properties. To the best of our knowledge, this work is the first detailed assessment of the postnatal mouse cornea's structure and biomechanics and warrants further investigation into the dynamic properties of the postnatal eye.

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review.

Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake. Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework. The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria. Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.

Human Capital and the Upward Occupational Mobility of Rural Migrant Workers in China

Research on the human capital and occupational mobility of Chinese rural migrant workers often focuses on how formal education is linked to upward mobility, and rarely accounts for the heterogeneity in the origin occupations. Conditioning on origin occupations, this study uses multivariable logistic regression models to explore the relationship between four human capital factors including formal education, professional training, professional certificates and the knowledge of foreign languages, and the likelihood of upward occupational mobility among rural migrant workers in the urban labor market in China. The findings confirmed the overall positive associations between human capital and upward occupational mobility, net of family background and demographic characteristics. Nevertheless, heterogeneous marginal effects exist for different human capital factors. Formal education is associated with the upward mobility of migrant workers whose first occupations are professional technicians. Foreign language proficiency is associated with the upward mobility for those with an origin occupation of industrial production personnel or business and service personnel. There is evidence for cohort differences, that foreign language proficiency is associated with the upward mobility of the older cohort with an occupational origin of industrial production personnel, and of the younger cohort with an occupational origin of business personnel, whereas high school degree only matters for the older cohort. This study contributes understanding to the mobility and stratification literature by: 1) distinguishing between four human capital factors including formal education, professional training, certificates, and foreign language proficiency, and revealing the heterogeneity in their relationship with upward mobility; 2) providing an innovative empirical approach to understand the relationship between human capital and occupational mobility that accounts for the origin and destination occupations of mobility; 3) contributing a life course perspective by revealing the link between origin and destination occupations, between education and employment, between the younger and older cohort, and between structural barriers (or incentives) and individual agency for human capital investment.

The Role of Women in Islamic Sacred Texts: A Critical Study of Women's Narratives and Authority in Islamic Tradition

This research aims to examine the role and authority of women in Islamic sacred texts, focusing on narratives within the Quran and Hadith and their implications for the social status and leadership of women in contemporary religious contexts. The urgency of this study stems from a significant discrepancy between women's representation in Islamic doctrine and their participation and recognition in broader religious and social power structures. Employing a qualitative methodology with a phenomenological approach, this study collected data from primary sources through in-depth interviews, as well as document analysis and secondary literature review, to explore interpretations of texts and prevailing practices. The findings reveal that although the sacred texts provide a basis for gender equality, traditional interpretations often restrict women's roles in leadership and authority capacities. Discussions on reinterpreting these texts with a more inclusive gender perspective offer opportunities to expand understandings of women's leadership in Islam. This study also highlights the importance of education in supporting women to take on more active roles in religious activities and leadership. Based on these findings, the research recommends adopting a more egalitarian interpretative approach in Islamic theology and integrating gender-inclusive religious education as strategies to overcome structural and social barriers that hinder women. These recommendations aim to encourage broader dialogue and fairer religious practices, supporting social change that recognises and promotes women's roles and authority in Muslim communities.

Can high-profile endorsements improve COVID-19 vaccine uptake and reduce hesitancy in Pakistan?

BackgroundWhile low- and middle-income countries continue to struggle to secure adequate COVID-19 vaccine supply, a potentially greater challenge is to induce adequate demand to overcome widespread vaccine hesitancy; vaccination uptake has historically been a contentious political issue in Pakistan. High-level endorsements by trusted actors are one way to potentially increase public vaccine confidence. Methods: Employing a four-armed randomized trial with 2,026 participants in June 2021, we examine whether endorsements by different actors (Prime Minister, prominent religious leader, doctors) influenced participants’ willingness to register for the COVID-19 vaccine. ResultsWe find high levels of vaccine hesitancy with nearly 35% of participants reporting that they do not intend to vaccinate against COVID-19. Endorsements failed to influence participants' desire to register for vaccination, and only 37% agreed to register on spot. However, we find that higher trust in government, male gender, and higher income/wealth were associated with participants' willingness to register. A follow-up phone survey was consistent with the main results. DiscussionOur study finds that endorsements appear to have little effect on people’s immediate willingness to register for vaccination. Our findings suggest messaging on its own may be insufficient to overcome widespread social and structural barriers to vaccine uptake.

"It's a Thing": What Nurse Elders Believe Novice Nurses Need to Know About Managing Emotional Labour.

Emotional labour (EL) can take a significant toll on nurses' mental health and well-being and has serious implications for the retention of nurses in the workforce. Nurse educators have struggled to prepare novices to manage EL or find serviceable resources with which to do so within the body of nursing literature, which is dominated by essentially unhelpful narratives and is absent of the practical, real-world wisdom of elder nurses. This exploratory research study illuminated elder nurses' experiential knowledge and beliefs of what is important for novices to learn about EL. Conventional Content Analysis (CCA) of qualitative survey data from 688 nurses with 20+ years of experience. CCA generated descriptive categories and sub-categories: What the elders themselves learned as student nurses, and their advice to novices in the individual realm, ("It's a Thing," healthy disengagement, supporting mental and physical well-being, reframing self-reproach), team realm (peer support, mentors), and institutional realm (structural barriers to mentors' support of novices, building novices' capacities for self-advocacy, resources to support health and well-being). The elders' data confronted and reframed legacy individuated narratives in the literature by supporting and contextualizing nurses' emotional work. Elders advised novices that EL is a reality requiring concrete strategies to manage it throughout their practices. Elders extended their focus for management of EL beyond the individual to include peer support, mentorship, and the structural conditions in which nurses perform their EL, highlighting the need to empower nurses by building their capacity for self-advocacy of their workers' rights.

Alkaline tetrahydrofurfuryl alcohol pretreatment technology to achieve value-added co-liquefaction of biomass

Although it is promising to convert biomass into high yield/high quality bio-oil through hydrothermal liquefaction (HTL), it still faces many challenges. Hence, a novel approach was proposed here to improve the yield and quality of bio-oil. The effect of alkaline tetrahydrofurfuryl alcohol (ATA) pretreatment on the preparation of bio-oil from walnut shell (WS) adopting isopropanol/water co-liquefaction was studied. By optimizing the concentration of pretreatment alkali, the ratio of liquefied solvent, reaction temperature and residence time, the results indicated that a 50/50 co-solvent ratio had the best liquefaction effect. Under conditions of 280 °C, 30 min, and 1%-ATA, the maximum yield and energy recovery rate (ERR) of total bio-oil were 62.76% and 34.07%, respectively. Various high-sensitivity characterization techniques were used to analyze the physicochemical properties of WS pretreatment and liquefaction products, confirming that ATA pretreatment effectively breaks the structural barrier of WS and promotes its conversion to bio-oil.